An assessment of the causes of malnutrition in Ethiopia: A ...

2.1. Introduction
In the early 1960s, the then Imperial Ethiopian Government recognized the
importance of identifying the nutritional status of the Ethiopian people by inviting Swedish
nutritionists to advise on the problem of nutrition in Ethiopia and to establish the Ethio-
Swedish Pediatrics Clinic of which the Children Nutrition Unit (CNU) was the most
important research and application department. The CNU focused on the development and
preparation of weaning foods for infants and children less than 5 years of age, strengthening
of laboratory food analysis, and the preparation of balanced food recipes from local staple
ingredients. Field stations were established at sites representing the food habits of Ethiopians
living in different localities of rural and urban areas. The findings and result of the activities
of the CNU were documented in a number of publications and monographs. The Pediatric
Clinic was incorporated into the Ethiopian Nutrition Institute (ENI) when ENI was
established under the Ministry of Health in 1968.
However, studies conducted in the late 1950’s and 1960s confirmed that the physical
status of the population, in relation to the energy required to accomplish different tasks, was
at a low level. The average body weight of adults at the national level was about 18 percent
below the standard at that time (ONCCP 1982). Thus, the establishment of ENI was a
milestone in pursuit of knowledge for dealing with the serious problems of malnutrition in
Ethiopia through training and research by collecting and disseminating data and information
on nutritional status among various groups. Although limited in coverage, surveys were
conducted on the nutritional status of various socio-economic groups (semi-pastoralists,
enset-growing farmers, cereal-based farming households, and urban dwellers) between 1963
to 1968 that include both direct (clinical, laboratory, anthropometrics) and indirect
(production, mortality rate, disease burden) measurements. The results showed that the
population faced serious shortages in energy, protein, and micronutrients as compared to
international standards (ibid, 9).
Understanding the problem of nutrition in a developing country like Ethiopia and
arriving at a consensus on the synergies and the integration of various causes of malnutrition
are deemed essential as a background for the development of a National Nutrition Strategy
(NNS). Three clusters of causes of malnutrition are identified as key sets of determinants for
the process of developing the NNS. These include the immediate causes, the underlying
causes, and the basic or root causes. This report focuses on the basic causes or basic
determinants of malnutrition.
This report consists of the following sections. After this introduction, a definition of
malnutrition and a conceptual framework on the causes of malnutrition, the global framework,
along with historical background on past scientific investigations of malnutrition and its basic
causes are presented. In section 2.2, a description of the major identifying characteristics of
the malnourished in Ethiopia and trends in malnutrition are presented. Section 2.3 identifies
and describes in detail the basic causes of malnutrition in Ethiopia, examining the macro and
structural characteristics of the socio-economic, political, cultural, and institutional structures
as they relate to malnutrition. Key implications of the assessment of the basic determinants of
malnutrition are presented in section 2.4, while section 2.5 presents a summary of the findings
and recommendations for future directions in formulating a sustainable National Nutrition
Strategy.
2.1.1. Defining Malnutrition
The concept of nutrition and its manifestation as malnutrition (both under and over
nutrition), involves complex processes at multiple levels, from indiv idual to the household to
the community to the national and international levels. A UNICEF Policy Review paper states
that, from the perspective of developing countries, “malnutrition results from inadequate
intake of nutrients and/or from disease factors that affect digestion” among which protein-
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